Individual provider Active NPI

Jeremy Andrew Pickell, MD

  • Pediatrics Physician
  • Charlotte, NC
National Provider Identifier
1518227883
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
183002 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 381-6806
Fax
(704) 381-6841
NPI assigned
May 21, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 183002 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 381-6806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210927003296 SC Practitioner - Pediatric Medicine 2466859806 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36285SCMDPharmacist
183002NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Affiliate Physicians CurrentSince Oct 1, 2021 Accepting new patients
Musc Affiliate Physicians Pediatrics CurrentSince Oct 1, 2021 Accepting new patients
University Medical Associates Past Accepting new patients

Locations

525 Verdae Blvd
#100
Greenville, SC 29607
Phone (864) 516-2800

9 Hawthorne Park Ct
Greenville, SC 29615
Phone (864) 286-1040

525 Verdae Blvd
#200
Greenville, SC 29607
Phone (864) 603-5600

145 E Poinsett St
Greer, SC 29651
Phone 86460356003222

559 Harrison Bridge Rd
Simpsonville, SC 29680

312 Harrison Bridge Rd
Ste A
Simpsonville, SC 29680

2430 Reidville Rd
Ste 102
Spartanburg, SC 29301

Interoperability endpoints

  • Direct secure messaging: jeremy.pickell@tribe513.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337558400000",
    "number": "1518227883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-381-6806",
            "fax_number": "704-381-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-381-6806",
            "fax_number": "704-381-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKELL",
        "first_name": "JEREMY",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "183002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.